Disseminated Toxoplasmosis with Bone Marrow Involvement

Clinical Image

Ann Hematol Oncol. 2018; 5(8): 1223.

Disseminated Toxoplasmosis with Bone Marrow Involvement

Collin K Chin1,2 and Jill Finlayson1,3*

¹PathWest Laboratory Medicine Australia

²Department of Hematology, Sir Charles Gairdner Hospital, Western Australia

³University of Western Australia

*Corresponding author: Jill Finlayson, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia

Received: November 08, 2018; Accepted: November 21, 2018; Published: November 08, 2018

Clinical Image

A 61-year-old man with acute lymphoblastic leukemia on maintenance oral mercaptopurine and methotrexate presented with confusion, night sweats and cough. Laboratory work-up showed pancytopenia with elevated inflammatory markers and liver enzymes. Computerized tomography showed trace pericardial fluid and small pleural effusions without evidence of infection. Broad-spectrum antimicrobial therapy was commenced and bone marrow (BM) biopsy was performed. The BM aspirate smear was hypocellular without evidence of haemophagocytosis or leukemic relapse. Examination demonstrated granulocytes with crescentshaped intracellular inclusions with prominent oval nuclei (panels A/B, Giemsa stain). Trephine biopsy showed similar findings with increased eosinophilic activity (panel C, hematoxylin & eosin stain). Serology was positive for Toxoplasma immunoglobulin M and immunoglobulin G of 5.0IU/mL (positive >3.0IU/mL). Polymerase chain reaction and sequencing analyses were positive for Toxoplasma gondii. Human immunodeficiency virus serology was negative. The patient deteriorated within 48 hours due to cardiac tamponade from disseminated toxoplasmosis and subsequently died.

Citation: Chin CK and Finlayson J. Disseminated Toxoplasmosis with Bone Marrow Involvement. Ann Hematol Oncol. 2018; 5(8): 1223.